Normal Perio Supplemental Flashcards
1
Q
What makes up the masticatory mucosa?
A
-keratinized stratified squamous epithelium -Dorsum of tongue, hard palate, and attached gingiva
2
Q
what is the lining of the mucosa made up of?
A
-non-keratinized stratified squamous epithelium -buccal mucosa -labial mucosa
3
Q
what is the specialized mucosa component of the oral mucosa?
A
- dorsum of the tongue
- taste buds, lingual papillae
4
Q
which 3 mucosa make up the oral mucosa
A
-masticatory mucosa -lining mucosa -specialized mucosa
5
Q
what are 2 histologic features of the masticatory epithelium?
A
-keratinized -rete pegs (rete processes, rete ridges)
6
Q
what are rete pegs?
A
-downward thickening of epidermis between the dermal papillae -they function in helping keratinized tissues resist forces during mastication
7
Q
what 3 main layers comprise the basement membrane?
A
-basal lamina -attaching proteins -lamina reticularis
8
Q
the basal lamina consists of the lamina lucida and lamina densa. what are the main molecules in each layer?
A
lamina lucida: -laminin -integrins -entactins -dystroglycans lamina densa: -collagen IV
9
Q
what two proteins make up the attaching proteins of the basement membrane?
A
-collagen VII -fibrillin
10
Q
what makes up the lamina reticularis of the basement membrane
A
-collagen III
11
Q
what are langerhans cells?
A
antigen-presenting cells that are important for immune system functions
12
Q
what 4 main components make up the peridontium?
A
-gingiva -cementum -periodontal ligament -alveolar supporting bone
13
Q
what are 3 types of gingiva?
A
-attached -unattached (margina, free) -interdental
14
Q
T or F: periodontal tissues are biologically interdependent and withstand changes with age and disease.
A
false: they are subject to variations and changes with age and disease
15
Q
what 4 tissues does the periodontium NOT include?
A
-enamel -dentin -pulp -surrounding bone of the alveolar process
16
Q
what are the 5 main functions of the periodontium?
A
-attach -resist -maintain -adjust -defend
17
Q
describe characteristics of periodontium functions
A
- tooth support
- shock absorber: withstand forces of mastication
- sensory receptor necessary for proper positioning of the jaw
- nutritive: blood vessels provide the essential nutrients to the vitality of the PDL
18
Q
what are 5 components of the gingival epithlium?
A
-keratinocytes -desmosomes -tonofilaments -basal lamina -hemidesmosomes
19
Q
4 anatomical areas of the gingiva
A
-free gingiva (marginal) -gingival sulcus -interdental gingiva (papilla) -attached gingiva
20
Q
what is the difference between the gingival sulcus and the periodontal pocket?
A
-gingival sulcus implies health -periodontal pocket implies disease
21
Q
what are the gingival boundaries?
A
-upper (coronal) edge is the gingival margin -lower (apical) edge is the alveolar mucosa
22
Q
Name these tissues:
A
23
Q
what part of the gingival sulcus does the free gingiva form?
A
soft tissue wall
24
Q
T or F:
free gingiva tissues meets the tooth in a thin, rounded edge called the gingival margin
A
true
25
what type of tissue makes up the free gingiva?
keratinized stratified squamous epithelium
26
T or F:
the gingival margin does not follow the contours of the teeth
false:
it follows the contours of the teeth, creating a wavy outline
27
what are the two gingival biotypes?
28
compare thin vs thick gingival biotypes
thin biotype:
* 1/3 sample, females
* slender teeth
* narrow zone of KG
thick biotype
* 2/3 sample
* quadratic teeth
* wide zone of KG
29
what is the gingival sulcus?
the space between the free gingiva and tooth surface
30
what are 4 characteristics of the gingival sulcus?
- V-shaped shallow space around the tooth
- clinically normal sulcus is 1-3 mm as measured by a probe
- base of sulcus is formed by junctional epithelium
- wall of sulcus is non-keratinized
31
is the inner wall of the gingival sulcus (sulcular epithelium) keratinized or non-keratinized?
non-keratinized, and has a semipermeable membrane
32
in a healthy individual, where is the base of the gingival sulcus? ...for an individual with inflammation?
- in a healthy individual, the base of the sulcus is the coronal aspect of the junctional epithelium; the JE is attached to the enamel
- in an individual with inflammation, the JE will likely be detached from the epithelium, so the base of the sulcus will be deeper
33
what are 4 functions of gingival crevicular fluid (GCF)?
- cleanses the gingival sulcus
- aids in adhesion of the epithelium to the tooth
- possesses antimicrobial properties
- exerts antibody activity in defense of the gingiva
34
in a clinically healthy gingival crevice, the resident bacterial plaque results in what? ...what does this create?
- the accumulation of high molecular weight molecules
- these molecules permate the intercellular regions of the epithelium, but are limited to the basement membrane
- creates osmotic pressure, drawing fluid from CT into the sulcus; this is the gingival crevicular fluid
35
describe how gingival crevicular fluid is a transudate of interstitial fluid
- GCF represents the interstitial fluid, which appears in the crevise as a result of an osmotic gradient
- this pre-inflammatory fluid is transudate
- on stimulation, it becomes inflammatory exudate
36
T or F:
in methods of collection of gingival crevicular fluid, more intracrevicular fluid is collected than extracrevicular fluid
false:
more extracrevicular fluid is collected
37
name 4 methods of collection of gingival crevicular fluid
- intracrevicular washings
- absorbing paper strips
- twisted threads
- micropipettes
38
what is a periotron?
an eletrical method devised for measuring gingival fluid absorbed on paper strips
39
gingival crevicular fluid is composed of enzymatic and non-enzymatic components. name the components of each.
enzymatic components
* host derived and other products
* bacteria derived
non-enzymatic components
* cellular component
* electrolytes
* organic component
40
name the 10 host derived enzymes that GCF is composed of
* acid phosphates
* alkaline phosphates
* alpha-1 antitrypsin
* arylsulphatase
* aspartate aminotransferase
* B-glucuronidase
* cathetpsin D, G
* matrix metalloproteins
* elastase
* plasminogen activators
41
name the 7 bacteria derived enzymes GCF is composed of
* acid phosphatase
* alkaline phosphatase
* collagenase
* hyaluronidase
* phospholipase-C
* phospholipase-A
* bacterial proteinases (endo and exopeptidases)
42
name the 3 cellular components found in GCF
* bacteria
* desquamated epithelial cells
* leukocytes (PMNs, lymphocytes, and monocytes) which migrate through the sulcular epithelium
43
name the 5 electrolytes of the GCF
* potassium
* sodium
* calcium
* magnesium
* fluoride
with inflammation, there is a positive correlation between [Ca] and [Na] and the Na/K ratio
44
what 2 organic compounds are found in GCF?
- glucose hexosamine
- hexuronic acid
45
T or F:
- glucose concentration in GCF is 3-4x lower than that in serum
- result of metabolic activity of adjacent tissues and the local microbial flora
false:
it is 3-4x higher than that in serum
46
what are the 6 metabolic end products produced as a result of the metabolic activity of adjacent tissues and local microbial flora?
* lactic acid
* urea
* hydroxyproline
* endotoxins
* cytotoxic substances
* hydrogen sulphide
47
what is the role of cytokines in GCF?
- they are potent local mediators of inflammation
- in GCF, they have been investigated as potential diagnostic markers for periodontal diseases
48
which cytokines have been investigated as potential diagnostic markers for periodontal disease?
- interleukin 1 alpha and beta
- interleukin 6 and 8
- tumor necrosis factor alpha (TNF-alpha)
- IL-1 alpha and beta have pro-inflammatory effects and defending on a variety of factors, can stimulate either bone resorption or formation
49
what is prostaglandin E2?
- PGE2 is a product of the cyclooxegnase pathway
- elevated levels in GCF found in patients with periodontitis compared to those with gingivitis
- PGE2 levels are 3x higher in patients with LAP compared to adult periodontitis
50
what are the normal characteristics of attached gingiva?
- color is pale or coral pink
- may be pigmented; more frequent in dark-skinned individuals; color ranges from light brown to black
51
what are functions of the attached gingiva?
- allows gingival tissue to withstand mechanical forces
- prevents free gingiva from being pulled away from tooth
52
what are normal clinical characteristics of the facial attached gingiva?
- texture in health is stippled but determined by genetics
- dense CT fibers attach gingival tissue to cementum and bone
53
what are the maxillary and mandibular average widths of normal facial attached gingiva?
- maxillary incisors - 3.5-4.4mm; premolars - 1.9mm
- mandibular incisors - 3.3-3.9mm; premolars - 1.8mm
- areas with smaller zones are more susceptible to periodontal issues; more common in the gingiva of the mandible
54
T or F:
the entire palate is attached tissue
true
with the exception of the free gingiva
55
where is interdental gingiva/papilla?
it is found in the space between the teeth
56
name 3 factors that largely determine gingival shapes
- relationship to teeth (crowns)
- genetics
- state of health
57
what is black triangle disease?
a small black triangle seen between the teeth that is present as a result of the papilla not making contact with the contact point of the teeth
58
what is the effect of crowding on papilla shape?
it makes it difficult to maintain
59
T or F:
if there is no contact between teeth, there can still be a papilla
false:
no contact, no papilla
60
What is the function of the Col?
it connects facial and lingual papillae
61
what are 3 characteristics of the Col?
- depression between facial and lingual interdental gingiva
- center is not keratinized
- more susceptible to disease
62
what different groups make up the Col?
- dentogingival grou
- circular group
- dentoperiosteal group
- alveologingival group
63
T or F:
the Col area is normally not keratinized, even if there is no contact point between the teeth (ie. no papilla)
false:
in Col areas where there is no papilla, it is keratinized
64
what are 3 characteristics of the junctional epithelium?
- it is continuous with sulcular epithelium
- it completely encircles the tooth
- on enamel and apically extends onto the CEJ
65
what tissue precedes junctional epithelium during development?
reduced enamel epithelium
66
describe the formation of the junctional epithelium during development
- reduced enamel epithelium is rapidly replaced with squamous epithelial cells once tooth erupts
- transformed reduced enamel epithelium and oral epithelium form dentogingival junction and junctional epithelium
- final conversion of REE to JE may not occur until 3-4 years post eruption
67
describe the 2 layers of the junctional epithelium
internal basal lamina attaches to enamel
* lamina densa
* lamina lucida
* hemidesmosomes
external basal lamina attaches to CT
* lamina densa
* lamina lucida
* hemidesmosomes
68
what is the dentinogingival unit?
the functional unit of junctional epithelium that is reinforced by collagenous fibers in the marginal gingiva
69
describe the length of the JE
- it varies according to stage of eruption
- Tooth first erupts – most of enamel covered by JE
- Tooth reaches occlusal plane – ¼ enamel surface covered
- Eventually JE lies close to CE junction
- Older patients with root exposure (passive eruption or disease) JE proliferates apically - firm attachment with cementum
70
describe the lamina propria of gingiva
good vasculature and source of nutrient to JE and source of GCF
71
T or F:
the JE is impermeable; tissue and cells cannot pass into GCF
false:
it is permeable, and tissue and cells can pass into GCF
72
describe the rate of turnover of the JE
- very rapid
- epithelial cells migrate coronally and shed into oral cavity via gingival crevice
- rate of turnover dependent on demands placed on tissue; directly related to degree of inflammation
73
T or F:
the JE has an attachment role and protective role, and it helps maintain integrity of the tooth and periodontium structure
true
74
describe the permeability of the JE with respect to disease processes
the permeability of the JE allows GCF and defense cells to pass across to protect underlying tissues from disease processes
75
describe how the JE and GCF are good indicators for severity of periodontal disease
-may contain neutrophils and other inflammatory cells indicating disease and state of health of periodontium
76
describe the 2 distinct layers of the lamina propria of the gingival CT
papillary layer
* forms finger-like extensions in the depressions delineated by the rete ridges
reticular layer
* located beneath the rete ridges
77
what are the 3 major gingival fiber groups?
- gingivodental group
- circular group
- transseptal group
\*they are primarily composed of type I collagen
78
what are the 6 minor gingival fiber groups?
- semicircular
- transgingival
- periosteogingival
- interpapillary
- intercircular
- intergingival
79
what are the cellular elements of gingival CT?
- cells make up 5% of gingival CT
- fibers make up 65% of gingival CT
- remainder is composed of proteoglycans, glycoproteins, and CT ground substance
80
name the 13 cellular elements in gingival CT
* fibroblasts
* osteoblasts
* chondroblasts
* chondrocytes
* epithelial cells
* mast cells
* adipose cells
* fixed macrophages and histiocytes
* eosinophils
* neutrophils
* lymphocytes
* plasma cells
* PMNs
81
name the fibrillar elements in the gingival CT
collagen approx 60%
* type I (majority)
* type III (reticular)
elastic fibers
oxytalan fibers
ground substance
* highly hydrated, gel-like
* surrounds fibers
82
about how wide the the PDL?
0.25mm
83
what is the attachment apparatus?
PDL + cementum + alveolar bone
84
name the 5 funcitons of the periodontal ligament
1. suspends and maintains tooth in socket
2. provides pressure and pain sensory feeling to tooth
3. provides nutrients to cementum and bone
4. builds and maintains cementum and alveolar bone of tooth socket
5. remodels alveolar bone in response to pressure
85
describe the collagen and elastic fibers of the PDL
collagen fibers
* principle fibers
* intermediate plexus fibers
* sharpey's fibers
* indifferent fiber plexus
elastic fibers
* oxytalan fibers
86
describe the statistical characteristics of the PDL
* varies in thickness: 0.1-0.25mm
* widest during heavy occlusion, thinner in nonfunctional teeth
* surface area of socket wall: 150-275sq mm in single root, and 450 for multirooted
* 2000/sq mm in non-functional, and 28,000 in functional
* diameter 2-3 micro m at eruption, double in fully functional teeth
* fiber bundles larger and less numerous on the bone surface than on cemental surface
87
what is the organization of the PDL fibers?
* transseptal group
* alveolar crest group
* horizontal group
* oblique group
* apical group
* interradicular group
88
name the 5 CT cells that make up part of the cellular elements of the PDL
1. fibroblasts
2. cementoblasts
3. cementoclases
4. osteoblasts
5. osteoclases
89
name the epithelial rest cells that make up the cellular elements of the PDL
rest cells of Malassez
90
name the defense cells that make up the cellular elements of the PDL
* mast cells
* macrophages
91
T or F:
neurovascular elements form part of the ground substance of the PDL
false:
they form part of the cellular elements of the PDL
92
does the cementum have its own blood/nutrient supply?
no
93
the cementum is bone-like. is it more or less resistant to resorption than bone?
more resistant
94
what is the cementum?
* thin layer of hard, mineralized tissue that covers the surface of the root
* light yellow
* overlies dentin
95
what is primary cementum? secondary cementum?
* primary cementum is acellular cementum
* secondary cementum is cellular cementum
96
describe the 3 cementoenamel junction relationships
* cementum overlaps enamel: 60-65%
* cementum does not meet enamel (gap): 5-10%
* cementum meets enamel at a butt joint: 30%
97
describe characteristics of bone
* surrounds and supports roots of teeth in upper and lower jaw
* existence of alveolar bone is dependent on presence of teeth: extractions lead to bone resorption
98
name 4 types of bone
1. alveolar bone proper (cribriform plate)
2. cortical bone
3. cancellous bone
4. periosteum (vascular)
99
describe the alveolar bone proper
* alveolus: bony socket that houses the root of the tooth
* large pores where blood vessels connect structures
* ends of PDL fibers are embedded in alveolar bone proper
100
describe characteristics of cortical bone
* layer of compact bone that forms hard outside wall of jaws on facial and lingual
* surrounds alveolar bone proper and gives support to socket
* thinnest in incisor, canin, premolar area and thickest in molars
* does not show up on radiographs
* alveolar crest most coronal portion
101
describe characteristics of cancellous bones
* spongy, lattice-like bone filler between cortical bone and alveolar bone proper
* oriented around tooth to form support for alveolar bone proper
102
describe characteristics of the periostium
* layer of connective soft tissue covering outer surface of bones
* collagenous tissues and an inner layer of elastic fibers
103
describe the vascular supply and innervation of the PDL
* vascular supply enters from three sources: apical vessels, penetration through the alveolar bone, anastamosis from the gingiva
* lymphatic vessels
* nerves
